You don’t build a bond without being present.
- James Earl Jones
“Will you follow me even after my cancer surgery?” the patient asks.
"I will continue to see you for as long as you are willing to return," I respond.
“Can we call you when we have questions?” the daughter asks.
"Of course," I answer.
“Why did she get cancer?" her husband wants to know.
"I don't know, but I will help you do what we can to keep it from returning." Soon, we are deep into a difficult discussion.
Tough questions keep physicians, nurses, pharmacists, and all healthcare providers busy. In order to evaluate and treat diseases, the demands of 21st century medicine require staying current with an unmanageable onslaught of clinical and basic science research studies. Office and hospital time is filled with performing procedures, keeping current on charting, and fulfilling administrative duties. The “softer” side of medicine — taking time to talk, provide explanations, and offering hope — takes a backseat if we view our main mission as providing intricate treatments for complex diseases. We see our work as an endless steam of tasks on a to-do list. We are soon sucked into the maelstrom.
In an earlier time, Lewis Thomas, MD — gifted physician, researcher, administrator, and essayist — described the primary tasks of a physician as they were viewed at the time of his father' medical school graduation in 1911:
“First of all, the physician was expected to walk in and take over; he became responsible for the outcome whether he could affect it or not. Second, it was assumed that he would stand by, on call, until it was over. Third, and this was probably the most important of his duties, he would explain what had happened and what was likely to happen.”
And how were physicians equipped to accomplish these tasks? Dr. Thomas amplified:
“The first two [taking over and standing by] needed a mixture of intense curiosity about people in general and an inborn capacity for affection, hard to come by but indispensable for a good doctor. The third, the art of prediction, needed education and was the sole contribution of the medical school.”
Thomas found medicine to be much the same when he started medical school in 1933. The good physician was known by these traits: Being accountable, being present, and making honest, informed predictions on behalf of patients.
These traits resonate today, don't they? In some ways, it feels as though it is harder than ever to keep our eyes on these simple goals of every patient interaction. These themes continue to resonate in the writings of thoughtful physician-authors such as Atul Gawande, Abraham Verghese, Siddhartha Mukherjee, and Louise Aronson. We try to teach and model them to our students and residents every day.
Interestingly, despite the revolution in health care and explosion of information, these three tasks remain vital components of our profession.
Just like in Dr. Thomas' time, we will never know the answers to every question, of course. But I have never regretted being accountable, present, and honest.
From Thomas L, The Youngest Science: Notes of a Medicine Watcher. New York: Penguin Books, 1983.